Peritoneal dialysis

It has been noticed for years that ultrafiltration (UF) is important for survival in peritoneal dialysis. On the other hand, precise and convenient UF measurement suitable for patient daily practice is not as straight forward as it is to measure UF in the lab. Both overfill and flush before fill used to be source of measurement error for clinical practice. However, controversy finding around UF in peritoneal dialysis still exists in some situation. The current study was to understand the difference between clinical measured UF and real UF. The effect of evaporation and specific gravity in clinical UF measurement were tested in the study.

Catheter dysfunction in peritoneal dialysis (PD) is a common complication leading to diminished quality of life, reduced dialysis and the potential to abandon PD and transition to hemodialysis (HD). While a majority of PD catheter dysfunctions can be managed with simple strategies, like the treatment of constipation, some cases involve dealing with multiple pathophysiologic mechanisms in the same patient and thus require more than one intervention.

Peritoneal dialysis in adults involves diffusion and osmosis through a peritoneal membrane, measuring 1 m2, that is highly vascularized (flow rate, 100 to 150 ml per minute) and has a total available capillary surface area of approximately 2 m2.1 For decades, glucose has been used as the prototypical crystalloid osmotic agent to drive water removal in peritoneal dialysis.2 Glucose is a small osmotic agent (molecular weight, 180 g per mole) that is prone to crystallization but easily diffuses across semipermeable membranes; hence, it is known as a crystalloid substance.

The ideal peritoneal dialysis fluid (PDF) should have a physiologic electrolyte and buffer composition and be supplemented with an osmotic agent that is nontoxic, nonimmunogenic, and not rapidly absorbed to the plasma compartment, but if so, then rapidly metabolized. Furthermore, it should produce steady osmotic ultrafiltration (UF) over the course of a dwell. So far, glucose (G) has been the universally used osmotic agent in peritoneal dialysis (PD), based on its relative efficiency, low cost, safety, and rapid metabolism in plasma. In addition, commercially available PDFs containing icodextrin (ICO) or amino acids (AAs) have been in clinical use for a long time.

The Purifier mobile peritoneal dialysis system aims to give patients a carefree approach to managing the illness which is often a time-consuming process and hindrance to everyday life. The flexible design is positioned on the user to mimic an operating kidney while the automated peristaltic pump system transports the dialysate through the body, eliminating the need for a heavy, cumbersome infusion stand. Discrete and comfortable, it allows patients to move freely with little thought to the device.

Variability in ultrafiltration influences prescriptions and outcomes in patients with kidney failure who are treated with peritoneal dialysis. Variants in AQP1, the gene that encodes the archetypal water channel aquaporin-1, may contribute to that variability.

Fresenius Medical Care, the world’s leading provider of products and services for individuals with renal diseases, has today announced a strategic distribution partnership with JMS Co. Ltd, a provider of medical devices and pharmaceuticals, in Japan. Under the agreement, JMS Co. Ltd. will distribute Fresenius Medical Care’s innovative home dialysis therapies in the Japanese market, providing patients with a wider range of dialysis choices to suit their lifestyle, enhance their wellbeing, and to help address the home healthcare needs of Japan’s aging population.

A common variant of a gene that facilitates water transport across cell membranes was associated with decreased ultrafiltration and an increased risk of death or failure of peritoneal dialysis in patients on peritoneal dialysis for end-stage renal disease (ESRD), a cohort study found.

Ultrafiltration is essential in peritoneal dialysis (PD) for maintenance of euvolemia, making ultrafiltration insufficiency preferably called ultrafiltration failure—an important complication. The mechanisms of ultrafiltration and ultrafiltration failure are more complex than generally assumed, especially after long-term treatment. Initially, ultrafiltration failure is mainly explained by a large number of perfused peritoneal microvessels, leading to a rapid decline of the crystalloid osmotic gradient, thereby decreasing aquaporin-mediated free water transport. The contribution of peritoneal interstitial tissue to ultrafiltration failure is limited during the first few years of PD, but becomes more important in long-term PD due to the development of interstitial fibrosis, which mainly consists of myofibroblasts.

The VR system – called stay•safe MyTraining VR – is designed for use in patients undergoing peritoneal dialysis, which uses the peritoneum in a person’s abdomen as the membrane through which fluid and dissolved substances are exchanged with the blood.

Acute kidney injury (AKI) is defined by a sudden loss of excretory kidney function. AKI is part of a range of conditions summarized as acute kidney diseases and disorders (AKD), in which slow deterioration of kidney function or persistent kidney dysfunction is associated with an irreversible loss of kidney cells and nephrons, which can lead to chronic kidney disease (CKD). New biomarkers to identify injury before function loss await clinical implementation. AKI and AKD are a global concern.

CloudCath, a medtech company based in San Francisco, has created the CloudCath system, a remote monitoring technology that provides clinicians with data on the spent dialysate fluid of at-home peritoneal dialysis patients. CloudCath is incorporated into the drain line of peritoneal dialysis systems, and wirelessly transmits data to the cloud, with proprietary algorithms then highlighting issues, such as infection, to clinicians.

Globally, 1 in 10 people have been diagnosed with chronic kidney disease and the number of people with advanced kidney disease is rising, but there are still over 2.5 million people that do not have access to lifesaving treatments. Why is this, and what can be done to help ensure everyone has equal access to lifesaving treatments such as dialysis?

The push to have more patients dialyzed in the home setting is gaining momentum in the United States (US) under programs like the ETC (ESRD Treatment Choices), in which some nephrology practices were mandatorily enrolled in 2021. The ETC is specifically designed to incentivise nephrologists to increase the number of patients utilizing home dialysis and increase the number of patients on the kidney transplant waiting list.

Fresenius Medical Care, a global leader in dialysis treatment, has taken another step in moving dialysis from clinical settings to the home. Fresenius introduced the Kinexus Therapy Management Platform for home dialysis, which connects clinicians to patients and helps create more personalized care. The cloud-based system supports management of peritoneal dialysis on the Liberty Select cycler and is designed to improve workflows, productivity and patient outcomes.

Silk fibroin has been widely used as fundamental components for the construction of biocompatible flexible electronics, particularly for wearable and implantable devices. Furthermore, in recent years, more attention has been paid to the investigation of the functional characteristics of silk fibroin, such as the dielectric properties, piezoelectric properties, strong ability to lose electrons, and sensitivity to environmental variables. Here, this paper not only reviews the preparation technologies for various forms of silk fibroin and the recent progress in the use of silk fibroin as a fundamental material but also focuses on the recent advanced works in which silk fibroin serves as functional components. Additionally, the challenges and future development of silk fibroin-based flexible electronics are summarized.

Sudden cardiac death (SCD) represents a major cause of death in end-stage kidney disease (ESKD). The precise estimate of its incidence is difficult to establish because studies on the incidence of SCD in ESKD are often combined with those related to sudden cardiac arrest (SCA) occurring during a haemodialysis (HD) session. The aim of the European Dialysis Working Group of ERA-EDTA was to critically review the current literature examining the causes of extradialysis SCD and intradialysis SCA in ESKD patients and potential management strategies to reduce the incidence of such events. Extradialysis SCD and intradialysis SCA represent different clinical situations and should be kept distinct.

“I think there’s a need for increased nursing support to these patients,” continued Prof Mellotte, who noted there were “relatively few” nurses assigned to home therapy provision. “We need pre-dialysis nurses [and] we need home therapy care nurses to provide that support to these patients. That is one of the barriers and we have been talking to the HSE about increasing the supports to these patients. Because most people will agree it is a better quality-of-life if you can do it, but you need training.”

A new analysis reveals that individuals with kidney failure have faced especially high hospitalization and death rates during the COVID-19 pandemic. The findings, which appear in an upcoming issue of JASN, support prioritization of these patients in COVID-19 vaccination programs.

Like most of our organs, our kidneys play an important role in the overall functioning of our body. These two bean-shaped organs sit directly below the rib cage, one on each side of the spine. Their primary job is to remove waste and fluid from the body, says , but they also maintain blood pressure and mineral levels, keep our bones strong, and help make red blood cells.

DaVita’s home care strategy has also led it to work with the provider’s largest dialysis competitor—Fresenius Medical Care—for the home-based hemodialysis machines that it picked up through its $1.9 billion acquisition of NxStage Medical. (Baxter)

The COVID-19 pandemic has and continues to have a profound impact on society and our everyday lives. As of March 2021, more than 2.5 million people around the world have died as result of the pandemic. Patients with kidney failure, particularly those receiving chronic dialysis treatment are at an increased risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) resulting in higher morbidity and mortality within this vulnerable population. Similarly, a recently published study highlighting the impact of COVID-19 on the dialysis population from Canada’s most populous province, Ontario, showed that patients with kidney failure receiving hemodialysis were five times more likely to be infected compared to the general population.